Immunologic response after 6 months of highly active antiretroviral therapy indicates a favorable clinical outcome in HIV-infected patients regardless of virologic response. This finding suggests that both immunologic and virologic markers should be used in clinical practice to evaluate treatment response.

This study suggests that wine intake may have a beneficial effect on all-cause mortality that is additive to the effect of alcohol. This effect may be attributable to a reduction in death from both coronary heart disease and cancer.

The available data suggest that garlic is superior to placebo in reducing total cholesterol levels. However, the size of the effect is modest, and its robustness is debatable. The use of garlic for hypercholesterolemia is therefore of questionable value.

A retroviral rebound syndrome similar to that seen in primary HIV syndrome can occur in patients with chronic HIV infection after cessation of suppressive antiretroviral therapy.

Interruption of therapy may be associated with profound viral rebound and recurrence of the acute HIV syndrome.

Clinicians caring for HIV-1–infected patients who are receiving highly active antiretroviral therapy must be aware of inflammatory reactions involving opportunistic infections, AIDS-associated malignant conditions, and infectious diseases.

Part one of this two-part article considers the ethical concerns about the use of placebo controls and describes the limited ability of active-control equivalence trials to establish efficacy of new therapies in many medical contexts.

Part two of this two-part article discusses more fully the ethical considerations for using placebo controls in particular settings. The value and relevance of placebo-controlled trials of new agents in situations in which proven effective therapy is available are also explored.

Grabar and colleagues' study in this issue points to the importance of assessing the virologic and immunologic responses to treatment in the context of the underlying pathogenetic process. By doing so, we will be able to reach the ultimate goal of antiretroviral therapy: to prevent illness and prolong survival among HIV-infected patients.

In this issue, Temple and Ellenberg address the ethical challenge presented by use of placebo controls. Under what circumstances are placebo controls ethical, and what alternatives are available?

To many health professionals, the ideal patient just lies there quietly and cooperatively, watching television between occasional bouts of meaningful interaction with his family. Bob didn't measure up to this standard.

The Under Toad in John Irving's novel The World According to Garp is a grim symbol of the uncertainty of recurrence that patients with cancer face.

Among the topics covered in this Update are the prevention of coronary artery disease, use of antithrombins, and treatment of congestive heart failure.